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Pharmacy 514
PharmacotherapyColleen M Terrif, PharmD, MPH, AAHIVP
Clinical Associate Proessor
W! Colle"e o Pharmacy
Deaconess Hospital an# $oc%&oo#
prin" '(15
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)*+ecties
D-rin" the therape-tics e.am P/1st-#ents &ill0
1 De2ne sel3care an# the #riers an#scope o sel3care
' Cate"orie the top 5 con#itions, inran%in" or#er, &here sel3me#icationis -se#
tate the three 67 8DA re"-late#9-estions &hich m-st *e -l2lle# inor#er to chan"e a me#ication rom
$. to )TC
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What is el3Care;
Care ta%en *y in#ii#-als to&ar#s theiro&n health an# &ell3*ein"
Incl-#es care e.ten#e# to others0 Chil#ren, amily
8rien#s, nei"h*orhoo#s, comm-nity
In#epen#ent
$eliance on one
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What is Health;
!niersity o Washin"ton 6'((=7 >Wellness Wheel< ?)nline@ Aaila*le rom0http0&&&&ashin"tone#-proostst-#entliehealthan#&ellnessima"esHealthBWellnessWheel+p"6Accesse# '1 March, '(117
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el Care Inoles
Improin" an#or maintainin" health Preention
Dia"nosis
Treatment0 Minor ailments
on"3term con#itions
Transition care0 Post illness or hospital, reha*ilitation
#ischar"e
Ima"e rom0 McEay Pharmacy Aaila*le rom0 http0&&&mc%aypharmacycompa"esin#e.asp;titleFMinorBailments
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Pop-lation Care3 HealthPyrami#
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Care Contin--m
The Self-Care Continuum
Pure SelfCareIn#ii#-alresponsi*ility
Pure MedicalCareA*#icate#
responsi*ility
Dailychoic
esiestyl
e
el3mana"e#ailments
on"3term
con#ition
s
Comp-lsory
psychiatric careMinor
ailments
Ac-te
con#itions
Ma+or
tra-ma
lthy living Minor aliments Long-term conditions In-hospital c
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el3Care In#-stry
-pplies, pro#-cts Me#ications0
Vitamins
Gat-ral pro#-cts Gon3prescription me#ications
Testin"
Accessi*le healthcare proi#ers6pharmacists7
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el3Me#ication )ptions
1 Gonprescription me#ications Who re"-lates;
'4( million people -se 6'(1' #ata7
1(' *illion in al-e 6ann-al sain"s7 tohealthcare system
Cons-mers spent ' *illion in '(1(
oer3the3co-nterJ 6)TC7
*ehin#3the3co-nterJ 6KTC7
' G-tritional Dietary -pplements Vitamin, mineral, her*, amino aci#
'L *illion in '(1(
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el3Me#ication )ptions
Gat-ral pro#-cts an# homeopathicreme#ies0
Incl-#in" complementary an#alternatie me#icine 6CAM7
4 *illion in '((=
4 Alcohol, to*acco, street #r-"s;;
Ima"e rom0 astsi#e Mar%etplace Aaila*le rom0http0&&&eastsi#emar%etcomcontent#eptnat-ralhtml
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Impact o el Care
Pain
Co-"hcol#
Aller"ysin-s
Heart*-rn
Ko&els
Inections
%in
(N 1(N '(N (N 4(N 5(N :(N =(N L(N O(N
2002 Non! Survey" #0$ %S & ' ()C in # months
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Driers o el3Care
ro&th o a"in" pop-lation $estricte# access to prescri*ers thr- HM)
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A"in" Pop-lation
=' million Q :5 *y '((
8astest3"ro&in"0 R L5
Heay prescription an#non3prescription -se
Me#s are accessi*le, orcon#itions common toel#erly
aety concerns
Ima"e rom0 Cana#ian eriatricsociety t-#ent ite Aaila*le
rom0http0cana#ian"eriatricscast-#ents
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.amples o el Care
Dia*etic CH8 6heart ail-re7
eere aller"y
8emale0 chil#3*earin"
Athlete
mo%er
Arthritis
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en#er Iss-es
ap &i#ens &ith a"e0 )erall0 5(05(
:53:O0 114 emales01(( males
Q L50 '=( emales01(( males More &omen report health pro*lems
than men
pecial nee#s0 Pre"nancy
Kreast3ee#in"
Contraception
l h i i l
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$ole o Pharmacist in el3Care
isten As% 9-estions
When to recommen#
What to recommen# When to reer
Co-nter misconceptions, misinormation
#-cation, proision o inormation0 Ver*al
Written
)ther reso-rces 6ie &e*site recommen#ations7
Ima"e rom0 APhA Aaila*le rom0
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Internet Pharmacies
Kene2ts0 cost, conenience $is%s0 co-ntereit, contaminate# an#
-nsae me#icationsS lac% o
cons-ltation, s-perision GAPK0
Inormation0 K-yin" Me#icine )nline &&&na*pnetpro"ramscons-mer3protection
*-yin"3me#icine3online
Cre#entialin"0 VIPP 6Veri2e# InternetPharmacy Practice ites7
$ecommen#e#0 BBBBBB pharmacies
http://www.nabp.net/programs/consumer-protection/buying-medicine-onlinehttp://www.nabp.net/programs/consumer-protection/buying-medicine-onlinehttp://www.nabp.net/programs/consumer-protection/buying-medicine-onlinehttp://www.nabp.net/programs/consumer-protection/buying-medicine-online8/9/2019 Pharmacy 514 Self Care MTM CTerriff Jan
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We*3Kase# Dr-"Inormation
$e"-lation; ac% o 9-ality control
Inacc-rate inormation har# to #iferentiate
H-"e n-m*ers an# #iersity o sites
Pop-lar topics0 Diseaseme#ical pro*lems 6search e.ample0
BBBBBBB7
Treatmentproce#-res .ercise2tness
Ge& to health ino3 ocial Me#ia0 8ace*oo%, /o-T-*e, T&itter, My pace
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$. to )TC &itch
When me# "oes "eneric $. mar%et share Pharmace-tical in#-stry loo%in" to improe sales
)TC #ose may *e less than $.
)TC me#s not coere# -n#er most ins-rance
plans May sae cons-mers an# mana"e# care
8DA re"-late#S m-st hae all 0 Can the patient a#e9-ately sel3#ia"nose the clinical
con#ition; Can this con#ition *e sel3treate# s-ccess-lly;
Is this )TC sae an# efectie or cons-mer -se -n#erthe con#itions o act-al -se;
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$. to )TC e.amplesIngredient *rand name %se
ansopraole Preaci# '43H$
$D,heart*-rn
enor"estrel Plan K )netep
Contraception
)mepraole Ue"eri#)TC
$D,heart*-rn
I*-proen,phenylephrine
A#ilCon"estion$elie
Pain, nasalcon"estion
8e.oena#ine Alle"ra Aller"ies
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Kehin#3the3Co-nter 6KTC7 r#class o me#ications3 Pharmacist onlyJ
Proi#es access to me#ications thatre9-ire sae"-ar#s or -se
Pharmacists ass-re appropriate selection,
#osa"e, an# screen or potentialinteractions
.amples0
Pse-#oephe#rine, Plan K yrin"es
WA0 Prescriptie a-thority 6protocol7
A##itional reso-rce0 &&&-spharmacistcomcontent#cons-ltByo-
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KTC 8actors to Consi#er
Pharmacist proi#e necessary co-nselin" Hae appropriate inrastr-ct-re to protect
cons-mer priacy
Cost iss-es thical consi#erationscontroersies0
Access to clean syrin"es ers-s #r-"paraphernalia
$eli"io-s o*+ections ers-s amily plannin"
Decon"estant ers-s meth prec-rsor
Ima"e rom0 .aminer Aaila*le rom0 http0&&&e.aminercomarticlepresi#ent3o*ama3si"ne#3into3la&3a3ne&33
l
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ae !se3 $ole oPharmacist
Actiely inole# in helpin" patients ns-re that patients are a*le to rea#
an# -n#erstan# la*elin"
Proi#e a##itional inormation, i nee#e# Help patients aoi# #r-"3interactions
Warn 6an# e#-cate a*o-t &hat to #o7a*o-t possi*le si#e efects an# aller"icreactions
Disc-ss stora"e an# han#lin"
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Me#ical iteracy
Illiteracy0 '( #iferent %in#s $ea#&rite
8-nctional
Healthme#ical
listersecom'(1'(4(4'(3types3o3illiteracy
$eco"nition an# cope
!na*le to rea#-n#erstan# ho& to ta%e me#s As% them to rea# the #irections on pill *ottle
&&&acpinternistor"archies'((((4illiteracyhtm
Chan e ho& o- comm-nicate
l C
http://listverse.com/2012/04/04/20-types-of-illiteracy/http://listverse.com/2012/04/04/20-types-of-illiteracy/http://www.acpinternist.org/archives/2000/04/illiteracy.htmhttp://www.acpinternist.org/archives/2000/04/illiteracy.htmhttp://www.acpinternist.org/archives/2000/04/illiteracy.htmhttp://www.acpinternist.org/archives/2000/04/illiteracy.htmhttp://listverse.com/2012/04/04/20-types-of-illiteracy/http://listverse.com/2012/04/04/20-types-of-illiteracy/8/9/2019 Pharmacy 514 Self Care MTM CTerriff Jan
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tora"e o el3CarePro#-cts
Temperat-re H-mi#ity
i"ht
.piration #ate
Ima"e rom0 -ic% an# imple Aaila*le rom0 http0&&&9-ic%an#simplecom#iet3&ei"ht3losshealthme#icine33 3 3
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tora"e o )TCs
Closet + ,itchenCainet *athroom MedicineCainet
Anal"esicsAntaci#s
Anti*iotic topicalAntihistaminesAntipyreticsAntiseptics
Decon"estantsHy#rocortisone topical
A#hesie *an#a"esA#hesie &raps, tape
Alcohol &ipesCali*rate# meas-rin"spoonDental 8loss
Disinectant8eminine care pro#-ctsa-e pa#s
ThermometerToothpasteMo-th&ash
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Dr-" Interactions
Dr-"3#r-"0 Antaci#s an# certain anti*iotics,
antiirals
Dr-"3oo#*eera"e0 Aspirin an# "arlic 6*lee#in" ris%7 Alcohol
Dr-"3#isease state0 ee e.ample
e" GAID3CH8, I, renal
Dr-" inormation so-rces
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I We Don
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Me#ications Ca-sin"A#mission
Prospectie, o*serational st-#y, !E 1L,L'( patients R 1: years o a"e
1,''5 a#missions
:5N #irectly relate# in L(N o cases
Me#ian ) L #aysS (15N atality
Most common me#s0 Aspirin
Di-retics
Wararin
GAID
Pirmohame# M et al 6'((47 >A#erse #r-" reactions as ca-se o a#mission to hospital0 prospectie analysis o 1L,L'(< 3
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Aller"ies to In"re#ients
Actie or inactie in"re#ients ortin" o-t an# appropriate
#oc-mentation0
Tr-e aller"y Intolerancesi#e efect
Mana"ement0 preention, treatment
Ima"e rom0 piPen Aaila*le rom0 http0&&&epipencoma*o-t3epipen
I ti I #i t
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Inactie In"re#ient.amples
Aspartame Kenal%oni-m chlori#e
l-ten 6search actiity7
actose Propylene "lycol
accharin
-l2tes /ello& tartraine
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TerriYsms
/o- can treat anythin" &ith a #r-"J /o- can ca-se anythin" &ith a #r-"J
8or eery recommen#ation hae 'alternaties rea#y
)ptions 6sel3care70 Gone el3care therapy
$eer
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Patient3Pharmacist
Cons-ltation
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MTM
1 Descri*e the serice as ace3to3acepatient assessment an# interentionto i#entiy an# resole #r-" therapypro*lems
' 8orm-latin" a me#ication treatmentplan to optimie the response tome#ications an# achiee patients
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